Trauma

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.

The word “Fracture” implies to broken bone. A bone may get fractured completely or partially and it is caused commonly from trauma due to fall, motor vehicle accident or sports. Thinning of the bone due to osteoporosis in the elderly can cause the bone to break easily. Overuse injuries are common cause of stress fractures in athletes.

Types of fractures include:

Simple fractures in which the fractured pieces of bone are well aligned and stable.

Unstable fractures are those in which fragments of the broken bone are misaligned and displaced.

Open (compound) fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.

Greenstick fractures: This is a unique fracture in children that involves bending of one side of the bone without any break in the bone.

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on the either side of the fracture line. These cells grow towards each other and thus close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.

Non-operative (closed) therapy

comprises of casting and traction (skin and skeletal traction).

Castingclosed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.

TractionTraction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thighbone.

Surgical Therapy

Open Reduction and Internal Fixation (ORIF)this is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.

External fixationExternal fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

Open fractures with soft-tissue involvement

Burns and soft tissue injuries

Pelvic fractures

Comminuted and unstable fractures

Fractures having bony deficits

Limb-lengthening procedures

Fractures with infection or non-union

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of cast or brace so that the bone become solid enough to bear the stress. Rehabilitation program involves exercises and gradual increase in activity levels until the process of healing is complete.

MeetCharles V. Toman, MD

Board Certified, Fellowship Trained Orthopedic Surgeon

I am 16 weeks post-op from my rotator cuff surgery by Dr. Toman and am very pleased with the outcome. I never once felt that I was in “assembly line surgery” but rather in the care of a dedicated compassionate surgeon from my initial visit through rehab. Charlotte County is very fortunate to have an […]

My first occasion to hear of Doctor Toman was on talk radio 1580AM. He was giving an interview on a less invasive procedure for knee replacement. I called a friend in New Hampshire who asked if I knew of an orthopedic doctor here in Punta Gorda to replace both of his knee joints. Next my […]

I just want to thank Dr. Toman for the new knee he installed in my right leg. You might not believe this but, 11 days after the operation I played 18 holes of golf at St. Andrews South in Punta Gorda. The next day I played 9 holes too. I swear it’s true. I have […]

I am almost 82 years old and have been suffering night and day with my left shoulder for 5 and a half years. Two weeks after Dr. Toman did my reverse shoulder replacement I was able to lift my arm over my head without any pain and no pain medication. For me this doctor is […]

I would like to first start off by saying that Dr. Toman is an awesome Surgeon.I went to see him for the pain I was having in my right elbow. After having an MRI done he diagnosed me with a torn tendon and decided to “Scope” my elbow. So on May 13th 2010 Dr. Toman […]

Dr. Charles Toman demonstrated his professionalism and dedication in caring for my broken wrist which healed very quickly and nicely. Just a note of thanks for all his attention and I wish him well in his continuing endeavors. Thanks again Dr. Toman.

Dr Toman gave me back my life in March of 2010. Dr. Toman performed Hip Scope surgery on my right hip, and literally has given me back the ability to do everyday things. Before my surgery I could not walk with out pain or sit for any length of time without getting extremely stiff in […]

Hello, My wife and I have both had surguries performed by Dr Toman, she with hip and knee and I with rotator cuff, each done authoscopically. We are very pleased with the outcomes as we are having quick recoveries. Physical Therapy has been going well next door at SOS Therapy with the Martins. Everyone has […]

It is without hesitation that I highly recommend Dr. Toman and his exceptional support staff to anyone in need of an orthopedic procedure. During the initial office visit he instilled confidence that surgery to repair my rotator cuff followed by occupational and physical therapies would produce positive results thereby alleviating the tremendous pain I had […]

Before my surgery, the catch of this great 35-inch grouper would not have been possible. Reeling in such a fish was difficult, not to mention lifing it for a photo. Now, because of the great repair to my torn rotator cuff done by Dr. Toman, not only can I go back to fishing and catching […]

Dr.Toman did a total knee for me in may.i feel so much better since,you can’t imagine! It’s going to take time for a full recovery,but i am well satisfied with the surgery.Everyone is amazed how fast I’ve come along and how small the scar is.Thank you vary much doc,i really appreciate it.

I would like to thank Dr. Toman and his staff for the excellent service I received before and after my rotator cuff surgery. It has been six months since the surgery and I am able to do everything I did before the injury and with no pain.

I had a hip scope procedure in April 2010 by Dr. Toman. After a few weeks of physical therapy with the Martins I was able to return to my normal activities. The entire recovery time was less than anticipated & the results have been great. It is so nice to be pain free and able […]

As a retired state trooper, and active sports official, I was experiencing severe pain in my shoulder joint that was interrupting my sleep and causing major discomfort. On the recommendation of another doctor I was seeing, I set up a consultation with Dr. Toman. It was agreed that a total shoulder replacement was necessary due […]

Dr.Charles Toman replaced my left knee in October of 2010. In 5 days I was walking, doing my outpatient rehabilitation and exercising. My 90 year old Aunt also had her knee replaced and she was walking, after just one week, to my house (which is about a block away) I can’t thank Doctor Toman enough, […]

Dr. Toman did a complete knee replacement on me in November of 2010. I was only in the hospital 3 days and at the end of 2 weeks I was in out patient therapy. Dr. Toman’s outstanding skill as a surgeon and advance technology had me up and moving well within 6 weeks. His professional […]

In the middle of July 2010 I had an unfortunate fall which resulted in the dislocation of my right shoulder. I was taken to the Portsmouth, NH Hospital where the shoulder was reset. About 12 weeks later the shoulder was still very uncomfortable and it was decided to have further x-rays and MRI which revealed […]

On Feb. 8, 2011 Dr. Toman performed a right total shoulder replacement and muscle re-attachment on me. I was 70/1/2 at the time. His skill was obvious by my recovery time. Ten weeks after surgery I was released from physical therapy. After my surgery Dr. Toman took my wife and son from the waiting room […]

It is one of the best decisions I have made. My shoulder was bothering me to the point that I had trouble sleeping and raising my arm. My wife kept after me to see a doctor. From my first visit with D.Toman, I knew that I had made the correct decision. He lets you know […]

Dr. Toman replaced my left shoulder at Fawcett Memorial Hospital at the beginning of April. I highly recommend Dr. Toman. There has been no pain throughout the procedure and my recovery. Home health care was arranged including physical therapy. Outpatient PT was started after 4 weeks and will be continued during my stay up north. […]